CMS/EIP Fiscal Report Center: 54
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 Page: 1
Agency Filter:EIP DEI DEIP
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 272 113.25 4190.25 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 204 209.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 482 637.25 23504.25 36.88
TCM-T1017TL-TARGETED CASE MANAGEMENT 418 1531.75 56619.25 36.96
Subtotal (Total Children Is Unduplicated) 830 2491.25 84313.75 33.84
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
EXIT-EXIT-TRANSITION ASSESSMENT 4 7.50 375.00 50.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 8 13.00 721.50 55.50
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 13 21.50 1145.00 53.26
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 5 6.00 300.00 50.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 17 17.50 875.00 50.00
CONOF-CONOF-CONSULT, OT, FACE TO FACE 11 11.00 500.00 45.45
CONOP-CONOP-CONSULT, OT, PHONE 1 1.00 25.00 25.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 3 3.00 125.00 41.67
CONSP-CONSP-CONSULT, SLP, PHONE 2 1.50 37.50 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 8 30.00 1500.00 50.00
INTR-INTR-INTERPRETER 9 24.00 1200.00 50.00
SHIN-T1027SC-INITIAL SHINE SERVICES, INDIVIDUAL 1 1.00 50.00 50.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 260 46119.0 32947.35 0.71
Subtotal (Total Children Is Unduplicated) 264 46214.0 37559.85 0.81
----------------------------------------------------------------------------------------------------------------
Total 48726.75 123018.60 2.52
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 904
----------------------------------------------------------------------------------------------------------------
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 21 21.75 804.75 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 0 0.00 0.00 0.00
D 1 0.50 18.50 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
4144 48704.50 122195.35 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 4166 48726.75 123018.60 0.00